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Biopsy of thyroid nodules: comparison of three sets of guidelines.

Authors
 Sung Soo Ahn  ;  Eun-Kyung Kim  ;  Dae Ryong Kang  ;  Sung-Kil Lim  ;  Jin Young Kwak  ;  Min Jung Kim 
Citation
 AMERICAN JOURNAL OF ROENTGENOLOGY, Vol.194(1) : 31-37, 2010 
Journal Title
 AMERICAN JOURNAL OF ROENTGENOLOGY 
ISSN
 0361-803X 
Issue Date
2010
MeSH
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Area Under Curve ; Biopsy, Fine-Needle* ; Child ; Diagnosis, Differential ; Female ; Humans ; Male ; Middle Aged ; Practice Guidelines as Topic* ; Predictive Value of Tests ; Sensitivity and Specificity ; Thyroid Nodule/diagnostic imaging ; Thyroid Nodule/pathology* ; Thyroid Nodule/surgery ; Thyroidectomy ; Ultrasonography, Interventional*
Keywords
fine-needle aspiration biopsy ;  thyroid ;  ultrasound
Abstract
OBJECTIVE: The purpose of this study was to compare the results with three sets of guidelines for fine-needle aspiration biopsy of thyroid nodules. MATERIALS AND METHODS: A total of 1,398 nodules confirmed with fine-needle aspiration biopsy or surgery were included in the study. We compared the diagnostic value of three sets of guidelines for ultrasound findings that should lead to fine-needle aspiration biopsy of a nodule. According to the Kim criteria, a nodule should have at least one of the following findings: marked hypoechogenicity, irregular or microlobulated margins, microcalcifications, or length greater than width. According to the Society of Radiologists in Ultrasound, biopsy should be performed on a nodule 1 cm in diameter or larger with microcalcifications, 1.5 cm in diameter or larger that is solid or has coarse calcifications, and 2 cm in diameter or larger that has mixed solid and cystic components, and a nodule that has undergone substantial growth or is associated with abnormal cervical lymph nodes. According to the American Association of Clinical Endocrinologists, a hypoechoic nodule with at least one additional feature, such as irregular margins, length greater than width, and microcalcifications, should be biopsied. RESULTS: For all nodules, the diagnostic accuracy of the Kim (area under the receiver operating characteristic curve [Az]=0.868) and American Association of Clinical Endocrinologists (Az=0.850) criteria was greater than that of the Society of Radiologists in Ultrasound criteria (Az=0.551). The number of nodules for which fine-needle aspiration biopsy was recommended (25.6%) was smallest with use of the American Association of Clinical Endocrinologists criteria, and the smallest number (7.3%) of missed malignant lesions was associated with use of the Kim criteria. The results did not change for the subgroup with nodules larger than 1 cm. CONCLUSION: The Kim and American Association of Clinical Endocrinologists criteria are more accurate than the Society of Radiologists in Ultrasound criteria. The American Association of Clinical Endocrinologists guidelines are recommended for achieving high specificity, and the Kim criteria may be chosen for higher sensitivity
Full Text
http://www.ajronline.org/doi/abs/10.2214/AJR.09.2822
DOI
10.2214/AJR.09.2822
Appears in Collections:
4. Graduate School of Public Health (보건대학원) > Graduate School of Public Health (보건대학원) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kang, Dae Ryong(강대용)
Kwak, Jin Young(곽진영) ORCID logo https://orcid.org/0000-0002-6212-1495
Kim, Min Jung(김민정) ORCID logo https://orcid.org/0000-0003-4949-1237
Kim, Eun-Kyung(김은경) ORCID logo https://orcid.org/0000-0002-3368-5013
Ahn, Sung Soo(안성수) ORCID logo https://orcid.org/0000-0002-0503-5558
Lim, Sung Kil(임승길)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/100427
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